Platelet-To-Lymphocyte Ratio Efficiency in Predicting Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis.

Background: The platelet-to-lymphocyte ratio (PLR) is applied as a potential first-line prognostic predictor for many cardiovascular diseases due to its simplicity and accessibility. This meta-analysis aimed to quantify the predictive power of PLR for major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), explore its predictive efficacy in different populations, and identify other potential influencing factors. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for eligible studies until February 7, 2025, based on the inclusion and exclusion criteria. The Newcastle-Ottawa scale (NOS) was employed for quality assessment. Sensitivity, specificity, summary receiving operating characteristic (SROC) and area under the curve (AUC) were combined using Stata 15.1 and Meta-DiSc software. Meta-regression analyses, subgroup analyses, threshold effect analyses, sensitivity analyses, and publication bias tests were performed. Results: Nine studies (7174 patients) were enrolled. High PLR could predict MACEs in ACS patients undergoing PCI, with 0.68 sensitivity (95% CI, 0.60-0.76), 0.65 specificity (95% CI, 0.57-0.73), and 0.72 AUC (95% CI, 0.68-0.76). Subgroup analyses noted that PLR better predicted MACEs after PCI in ACS patients in the subgroup with a higher proportion of female patients and the subset aged >60 years. Meta-regression analyses unveiled that study type ( Conclusions: High PLR levels have favorable values in predicting in-hospital and long-term MACEs after PCI in ACS patients. The PLR had greater sensitivity and an improved ability to identify risk in patients aged >60 years and the subgroup with a higher proportion of women and was also more sensitive to in-hospital MACEs. The PROSPERO Registration: No. CRD42024537586, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024537586.